Needing feedback on dose

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Voula

Voula

Member Since 2014
Hi everyone. After Lucy had some lower glucose levels a few days ago we decreased the dose from 3 units to 2.75 units because her glucose level went down to 2.3/41 but her glucose levels have been high again for a few days now. Early this morning it looked like her glucose levels were coming down but they went up again. How long do we stay at 2.75 units? Thank you.
My previous post: http://www.felinediabetes.com/FDMB/...-59-41-5-63-6-88-7-108-9-128-pmps-337.131117/
 
Good morning!

It can sometimes be hard (at least for me) to determine if a dose is a "failed reduction" or if your kitty needs more insulin. In Lucy's case, you've held this dose for 8 cycles and you haven't seen very much blue, let alone green. I'd consider this a failed reduction and go ahead and increase the dose back to 3.0u.
 
Good morning Sienne. I am new to this so I wasn't sure what to do. So if we had a too low reading with 3 units should I be concerned about giving 3 units again? Thank you.
 
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When you reduce, the depot drains a little bit lower.
When you return to the previous dose, it may take 3-5 days for the depot to return to its previous state. This gives you a time period to monitor for safety.
 
I am a bit confused about the dose changes. I understand it will take a few days for the 3 units doses to have an effect. But because we had the lower reading of 2.3/41 does this mean if we increase back to 3 units there is a greater risk of hypoglycemia happening? Apart from episodes of lower readings Lucy continues to have high glucose levels which 2.75 units our current dose is not bringing down but then she did have some lower readings on 2.75 units when she was on that dose before the increase to 3 units. A question I have is this. Is it possible that the lower readings we have had are not so much connected with the dose of insulin but with Lucy's pancreas having little bursts of producing more insulin again regardless of insulin dose? In which case we definitely need to increase the insulin dose. The other explanation is that the insulin will bring down the glucose levels more often once Lucy gets used to having lower glucose levels more often in which case we may simply need patience at either 2.75 units or 3 units.
 
You're concern makes sense. The other option is to try to measure a consistent dose that's between 2.75 and 3.0u. To be honest, though, looking at Lucy's numbers before that 41 and after, I think you're in pretty good shape to raise the dose back up to 3.0u. However, you're there with Lucy and know her best. It's up to you to decide what is best for her and comfortable for you.

FWIW, the protocol suggests that if a dose reduction fails, you return to the last good dose. However, you also don't want to plunge BG levels overly low.
 
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We gave fat and skinny doses which we think was adding a drop or subtracting a drop. We figured there are about 3 drops in 0.25u. So you could go to a fat 2.75 (one more drop) or a skinny 3.00 (two more drops from 2.75, 1 less drop from 3.0). If this is confusing, then ignore what I wrote. I'm an engineer and I like details. :joyful:
Liz
 
Hi Voula, Serryn in disguise - insulin needs change so it's not necessarily true that because 3 units took her to 41 previously that the same dose is going to do the same thing again. She definitely looks like she needs an increase. I think I would go the full 0.25
 
Thank you everyone. We just got home from the vet. The vet suggested a dose between 2.75 units and 3 units. Either 3 units in the morning and 2.75 units at night or a fat 2.75 units twice a day. We also got a referral for a dental vet as we think Lucy has some pain in her teeth and she gave us some temgesic pain relief for a few days and I am thinking if the dental pain is relieved it might cause the glucose levels to come down too. I think I will try a fat 2.75 units twice a day and see how we go with that dose. I am very anxious about the dental work whilst Lucy's glucose levels are still high but the vet thinks we should do the dental work soon.
 
Good plan to go to a dental specialist and get her teeth looked at. For what it's worth, for Neko's first dental, red was still her favorite morning PS colour. :rolleyes: I'd also recommend you get a full set of X-rays done. Neko had a dental last week, and the X-rays showed a periodontal pocket down to the jaw. The tooth was extracted, but looked perfectly fine on visual inspection. Lots can happen below the gum line that we can't see. If there is dental infection, in can definitely impact blood glucose.
 
Wendy&Neko said:
Good plan to go to a dental specialist and get her teeth looked at. For what it's worth, for Neko's first dental, red was still her favorite morning PS colour. :rolleyes: I'd also recommend you get a full set of X-rays done. Neko had a dental last week, and the X-rays showed a periodontal pocket down to the jaw. The tooth was extracted, but looked perfectly fine on visual inspection. Lots can happen below the gum line that we can't see. If there is dental infection, in can definitely impact blood glucose.
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Thank you so much Wendy. I will take a not of the point you made about getting a full set of dental xrays done and ask for that to be done. It is comforting to know that Neko had red numbers for her first dental and that she did okay with it. I feel terrified about getting the dental done about the anesthetic but mostly because of the fear of ketoacidosis as Lucy developed ketones after a sedative for a blood test a few months ago when she was first diagnosed. Lucy also has had vestibular syndrome and has residual vertigo issues from that and after the sedative she could not walk for one day and I am even anxious to give her the temgesic the vet gave us today in case Lucy has pain from her teeth. I also read temgesic for injection has glucose in it. So I need to ask the vet about that too. I feel a bit of a nervous wreck at the moment with all the worrying I am doing.
 
My dental specialist has staff assigned to monitor the heart and blood pressure during the procedure. They deal with a lot of older animals with issues which made me feel better. Neko has a heart murmur. One option (at least here) is to get a board certified vet anesthesiologist to assist in the procedure. I imagine the dental vet would insist on the full set of X-rays. We do have a post on Dental Procedures.
 
Be sure to mention to the vet the sensitivity to anesthesia; it may be possible to use some local nerve block injections in order to reduce the overall gas anesthesia a tad. Plus there are different anesthetics possible and there may be one that would be better, or perhaps have a reversal agent to reduce after effects.
 
Wendy&Neko said:
My dental specialist has staff assigned to monitor the heart and blood pressure during the procedure. They deal with a lot of older animals with issues which made me feel better. Neko has a heart murmur. One option (at least here) is to get a board certified vet anesthesiologist to assist in the procedure. I imagine the dental vet would insist on the full set of X-rays. We do have a post on Dental Procedures.
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Thank you again Wendy. I have spoken to the staff at the veterinary teaching hospital and they will have a vet anesthetist do the anesthetic. Lucy has had an anesthetic there before and a vet anesthetist did the anesthetic then as part of the diagnostic tests that were done to diagnose her vertigo issues.
 
Thank you BJM. I will definitely mention the sensitivity to anesthesia to the vets at the vet teaching hospital when we see them. Our vet will also write to them informing them too.
 
To help in keeping warm I send Vyktor in with little baby socks to wear - they've almost stopped looking at me like I'm nuts now!
 
Hi Serryn. Do you mean if Vyktor needs an anesthetic you send him in with socks? If so, that is so cute.
 
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Anne & Zener (GA) said:
We gave fat and skinny doses which we think was adding a drop or subtracting a drop. We figured there are about 3 drops in 0.25u. So you could go to a fat 2.75 (one more drop) or a skinny 3.00 (two more drops from 2.75, 1 less drop from 3.0). If this is confusing, then ignore what I wrote. I'm an engineer and I like details. :joyful:
Liz
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Thank you so much Liz.
 
I think if Lucy needs a dental, she may have issues that are keeping her blood sugar high. Dealing with those dental issues right now may help her blood sugar improve, usually if the vet can see anything that's wrong in their mouth, there's a lot more that they can't see. Not always, but dental issues are so common with diabetic cat that it's good to get their teeth cleaned and checked out in case there's any bigger issues there.

Also you do want to give the same dose morning and evening. Giving different doses am and pm can cause wonky cycles.
 
julie & punkin (ga) said:
I think if Lucy needs a dental, she may have issues that are keeping her blood sugar high. Dealing with those dental issues right now may help her blood sugar improve, usually if the vet can see anything that's wrong in their mouth, there's a lot more that they can't see. Not always, but dental issues are so common with diabetic cat that it's good to get their teeth cleaned and checked out in case there's any bigger issues there.

Also you do want to give the same dose morning and evening. Giving different doses am and pm can cause wonky cycles.
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Thank you Julie. Yes the dental vet and the local vet both said the same thing that Lucy's dental issues may be preventing control of her diabetes. I decided to give the same dose morning and night. I am so anxious about the dental and the anesthetic. We don't know for sure if the dental vet will do the dental work tomorrow as it depends on what she thinks of Lucy's glucose levels but she said cats don't always have to have complete control of their diabetes to have a dental done and our local vet would be happy to do a dental now.
 
I'm confused - are you saying that she may have a dental done tomorrow? If so, did they give you directions on feeding her tomorrow and her insulin dose in the morning?

I think most cats here on FDMB aren't completely controlled before having a dental done if they need one.
 
Hi Julie. We have an appointment with the dental vet who will assess Lucy's teeth and if she thinks Lucy's glucose levels are acceptable to have the dental done tomorrow she will do it tomorrow after the consultation appointment. We have instructions on fasting and insulin dose. I emailed her and she emailed me back to say half the insulin dose in the morning with half of the usual amount of food. But we are on a late insulin schedule at the moment at midday and midnight so I am to give a normal meal and normal dose of insulin at midnight and then a small snack very early morning if that is what Lucy has usually but we can skip the small snack if I want to. Then when she is recovered from the anesthetic if we have the dental done we will check Lucy's glucose level and can give the midday dose of insulin then. Lucy will have blood tests done to see if she can have the dental done and her blood glucose will be checked just before the dental too.
 
Thank you so much Julie. I am putting that on my notes too that we may need to skip the insulin dose after the dental and speak to the vet about it.
 
Best of luck with the dental! Your decision on dose in the PM may also depend on what gets done. If Lucy has several extractions, she may not feel much like eating and you don't want to have to syringe feed in a sore mouth. I don't know if you can get an all meat babyfood there (we can't in Canada, but I stocked up on a trip to the US), but something plain meat puree is easy to eat and the kitties all seem to like it. If she's hungry when you get home after surgery, just do a tsp every 20-30 minutes as anesthesia can also affect the GI system.

Make sure they send you home with some pain relief - we used buprenorphine.
 
Hi Serryn. Do you mean if Vyktor needs an anesthetic you send him in with socks? If so, that is so cute.
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Yep - and it is pretty cute :)

I hope they can do the dental and get it out of the way and off your mind. If they want to give you tramadol (for pain relief) see if you can't get the buprenorphine instead. Liquid tramadol can be quite nasty with kitties getting really out of it on it and frothing at the mouth when they take it - a little distressing for the kitties and us beans!
 
Wendy&Neko said:
Best of luck with the dental! Your decision on dose in the PM may also depend on what gets done. If Lucy has several extractions, she may not feel much like eating and you don't want to have to syringe feed in a sore mouth. I don't know if you can get an all meat babyfood there (we can't in Canada, but I stocked up on a trip to the US), but something plain meat puree is easy to eat and the kitties all seem to like it. If she's hungry when you get home after surgery, just do a tsp every 20-30 minutes as anesthesia can also affect the GI system.

Make sure they send you home with some pain relief - we used buprenorphine.
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Thank you Wendy. I have noted all your suggestions too. I don't know if Lucy would accept assist feeding with a syringe but I will try if I need to do it. I can assist feed as I assist fed my Rosie successfully so that will be a factor too in deciding whether to skip the dose after the dental procedure. I looked for a suitable baby food for Rosie last year and could not find one. I can put some low carb food in a blender and add water to it to make it soft so it doesn't need chewing. I have Hills a/d from when Rosie needed it but it is too high carb. I will feed small amounts regularly as you said.
 
Vyktors Mum said:
Yep - and it is pretty cute :)

I hope they can do the dental and get it out of the way and off your mind. If they want to give you tramadol (for pain relief) see if you can't get the buprenorphine instead. Liquid tramadol can be quite nasty with kitties getting really out of it on it and frothing at the mouth when they take it - a little distressing for the kitties and us beans!
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Hi Serryn. The local vet gave me some buprenorphine to either give Lucy orally or give by injection in case she had pain until we saw the dental vet. But then I read it had glucose in it and decided seeing as Lucy was eating well and it was only a few days till the appointment with the dental vet that we would wait. So I have a two day supply and I will ask the dental vet for more if we need it. The local vet wanted to give me metacam but I said I was too anxious about it. She wanted to give me metacam as she thinks Lucy might have a bit of arthritis too. So I asked for buprenorphine instead.
 
Buprenorphine should not have sugar in it.

You do not want to give Metacam. It has a black box warning (the most dire warning the FDA can give) due to it's causing acute renal failure in cats. Good call on your part!
 
Hi Sienne. Thank you. I looked up temgesic which is the brand name of buprenorphine and it said the other ingredients were glucose, water for injections and hydrochloric acid. This seemed to be for temgesic injections and the vet said I can give Lucy the temgesic either orally or by injection so I thought I would hold off on giving it and speak to the dental vet tomorrow about it. The local vet said that she recently went to a seminar on metacam and it was discussed that American vets were giving too high doses of metacam because the doses were based on the dose the company worked out would be profitable for the company or so our local vet said. She said she gives 60% of the recommended dose and has had no issues but she understood my anxiety about it. Interestingly an Australian feline vet has done a study on metacam and cats with arthritis and found an interesting side effect which was less progression of kidney disease and no major issues. We usually read that metacam is not good for kidneys. But I would rather avoid it if there are alternative medications.
 
that's very interesting about the Metacam. We took punkin for acupuncture treatments and that vet gave his own cat metacam. I've heard a fair number of people from outside N. America that use metacam. My acupuncture vet said that it is definitely dose-related. I suspect we're sensitive on it here on FDMB because one of our kitties, Latte, died from getting metacam. That was just about the time I joined, or maybe not too long before. His person, Carolyn, used to post regularly about it.

Punkin got bupe orally and also via injection for many months. But you may have a different formulation than we have here in the US.

How did today go for Lucy?
 
Thank you Julie. I am anxiously waiting to see how Lucy is doing after her dental and waiting to speak with the vet. I requested no metacam.
 
Thank you everyone for your good wishes. We are home now and Lucy is recovering really well from her dental today. She had two teeth out and teeth cleaning and she cleaned the plate at the hospital within an hour of the procedure. She ate with gusto when we got home too. The vet prescribed a reduced insulin dose after the procedure and I gave that to her at the hospital after she ate. Her blood tests were all good and now we are waiting on the results of a urine culture to rule out any urinary tract infections even though Lucy has no symptoms of infection. The vet wanted to make sure any infections were addressed so as to help regulate Lucy's diabetes. Thank you again.
 
Wonderful post dental report Voula. :cool:
I'm a huge fan of regular dental cleanings. Black Kitty would not be OTJ if his teeth and gums had not been attended to. It was his Achilles heel.

easy does it with food - a little at a time - anesthesia slows down digestion which could result in Lucy vomiting.
anesthesia can lower BG values as well so you want to be confident Lucy will eat if you need her to.
Did the vet send you home with any pain meds for Lucy?
 
Sandy and Black Kitty said:
Wonderful post dental report Voula. :cool:
I'm a huge fan of regular dental cleanings. Black Kitty would not be OTJ if his teeth and gums had not been attended to. It was his Achilles heel.

easy does it with food - a little at a time - anesthesia slows down digestion which could result in Lucy vomiting.
anesthesia can lower BG values as well so you want to be confident Lucy will eat if you need her to.
Did the vet send you home with any pain meds for Lucy?
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Thank you Sandy. Yes I won't feed Lucy too much though she has eaten enough. We have buprenorphine which the local vet had given us the other day in case we needed it before we saw the dental vet. Lucy had an injection for pain before we left the hospital to come home and also one of the sedative medications had pain relieving properties too. She also had a nerve block so her mouth will be numb for a while too. Lucy looked like she didn't need pain relief but we decided to give her the pain relief medication before we came home in case she had pain later on.
 
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